Optimum BMI?

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Re: Optimum BMI?

Postby JeffN » Sun Sep 01, 2019 7:13 am

Body mass index and the risk of disability retirement: a systematic review and meta-analysis.
Occup Environ Med. 2019 Aug 29. pii: oemed-2019-105876. doi: 10.1136/oemed-2019-105876. [Epub ahead of print] Review.
PMID: 31467042

Abstract

The aim of this study was to determine the associations of body mass index (BMI) with all-cause and cause-specific disability retirement. Literature searches were conducted in PubMed, Embase and Web of Science from their inception to May 2019. A total of 27 (25 prospective cohort and 2 nested case-control) studies consisting of 2 199 632 individuals qualified for a meta-analysis. Two reviewers independently assessed the methodological quality of the included studies. We used a random effects meta-analysis, assessed heterogeneity and publication bias, and performed sensitivity analyses. There were a large number of participants and the majority of studies were rated at low or moderate risk of bias. There was a J-shaped relationship between BMI and disability retirement. Underweight (hazard ratio (HR)/risk ratio (RR)=1.20, 95% CI 1.02 to 1.41), overweight (HR/RR=1.13, 95% CI 1.07 to 1.19) and obese individuals (HR/RR=1.52, 95% CI 1.36 to 1.71) were more commonly granted all-cause disability retirement than normal-weight individuals. Moreover, overweight increased the risk of disability retirement due to musculoskeletal disorders (HR/RR=1.26, 95% CI 1.15 to 1.39) and cardiovascular diseases (HR=1.73, 95% CI 1.24 to 2.41), and obesity increased the risk of disability retirement due to musculoskeletal disorders (HR/RR=1.66, 95% CI 1.42 to 1.94), mental disorders (HR=1.29, 95% CI 1.04 to 1.61) and cardiovascular diseases (HR=2.80, 95% CI 1.85 to 4.24).The association between excess body mass and all-cause disability retirement did not differ between men and women and was independent of selection bias, performance bias, confounding and adjustment for publication bias. Obesity markedly increases the risk of disability retirement due to musculoskeletal disorders, cardiovascular diseases and mental disorders. Since the prevalence of obesity is increasing globally, disease burden associated with excess body mass and disability retirement consequently are projected to increase.
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Re: Optimum BMI?

Postby JeffN » Tue Sep 24, 2019 12:51 pm

Excess Body Weight and the Risk of Liver Cancer: Systematic Review and a Meta-Analysis of Cohort Studies.
Yang C, Lu Y, Xia H, Liu H, Pan D, Yang X, Sun G.
Nutr Cancer. 2019 Sep 23:1-13. doi: 10.1080/01635581.2019.1664602. [Epub ahead of print]
PMID: 31544511
Abstract
Objective: To update and expand the previous meta-analysis including all prospective studies on the issue of the associations between overweight, obesity, and liver cancer risk. We also performed a meta-regression to investigate a potential nonlinear and/or linear association between body mass index (BMI) and liver cancer risk. Methods: Literature search was conducted in four libraries from the beginning of indexing for each database to 1st September, 2018. Results: The summary risk estimate was statistically significant on the association between overweight and the risk of liver cancer incidence (relative ratio [RR] = 1.19). The RRs were significantly stronger in people with known liver disease with overweight than in the general population with overweight (RR = 1.50 vs. RR = 1.10; Pdifference = .02). The meta-analysis showed an increase by 87% on the risk of liver cancer incidence in obesity categories, relative to categories of normal BMI (RR = 1.87, P < .01). Moreover, the results showed that, overweight was associated with 9% increased and obesity with 66% increased for risk of liver cancer mortality. In linear model, the relative risks of liver cancer were 1.32 for continuous BMI per 5 kg/m2 increase. Conclusion: This meta-analysis supports the hypothesis that overweight, obesity may significantly increase liver cancer risk.
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Re: Optimum BMI?

Postby JeffN » Sat Dec 14, 2019 11:36 am

Association of Adult Weight Gain With Major Health Outcomes Among Middle-aged Chinese Persons With Low Body Weight in Early Adulthood. JAMA Netw Open. 2019 Dec 2;2(12):e1917371.
doi: 10.1001/jamanetworkopen.2019.17371.PMID: 31834393
https://jamanetwork.com/journals/jamane ... le/2757482
https://cdn.jamanetwork.com/ama/content ... 1_prod.pdf

IMPORTANCE:The association of weight gain from early to middle adulthood with disease risk has not been adequately studied.

OBJECTIVE:To investigate the association of adult weight gain with major health outcomes in a Chinese population with low body weight in early adulthood.

DESIGN, SETTING, AND PARTICIPANTS:This population-based cohort study assessed data from 48 377 women and 35 989 men aged 40 to 59 years at recruitment in 2 prospective cohort studies in China. The Shanghai Women's Health Study recruited 74 941 women, aged 40 to 70 years, from January 1, 1996, to December 31, 2000, and the Shanghai Men's Health Study recruited 61 482 men, aged 40 to 74 years, from January 1, 2002, to December 31, 2006. This analysis was conducted from September 1, 2017, to April 30, 2018.EXPOSURES:Weight gain from 20 years of age to 40 to 59 years of age.

MAIN OUTCOMES AND MEASURES:Mortality and incidence of cancers and other chronic diseases.RESULTS:This analysis included 48 377 women (mean [SD] age, 47.8 [5.3] years) and 35 989 men (mean [SD] age, 49.6 [5.1] years). Per 5-kg weight gain from early to middle adulthood was associated with an approximately 10% (hazard ratio [HR], 1.09; 95% CI, 1.04-1.14 for men; HR, 1.14; 95% CI, 1.11-1.19 for women) elevated all-cause mortality and a greater than 20% (HR, 1.26; 95% CI, 1.16-1.38 for men; HR, 1.23; 95% CI, 1.14-1.33 for women) cardiovascular disease-related mortality in later life among individuals who reached a body mass index (BMI) of 23 or higher at middle adulthood. Body mass index at middle adulthood also modified the association of weight gain with risk of obesity-related cancers, with weight gain of 20 kg or more associated with increased risks both for men (HR, 1.34; 95% CI, 1.07-1.67) and for women (HR 1.45; 95% CI, 1.24-1.68). No similar associations were found for individuals with a BMI of 18.5 to 22.9. Regardless of BMI, weight gain was associated with elevated risks of type 2 diabetes, hypertension, fatty liver disease, stroke, gout, and gallstones, particularly for type 2 diabetes (HR, 7.87; 95% CI, 6.91-8.97 for women; HR, 4.95; 95% CI, 4.23-5.79 for men) and fatty liver disease (HR, 3.68; 95% CI, 3.42-3.95 for women; HR, 2.83, 95% CI, 2.56-3.13 for men) in individuals with weight gain of 20 kg or more compared with those with a healthy weight.

CONCLUSIONS AND RELEVANCE:This study found that weight gain from early to middle adulthood was associated with disease incidence and mortality in later life. The BMI at middle adulthood modified the association of weight gain with mortality and cancer incidence but not risk of other major chronic diseases.
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Re: Optimum BMI?

Postby JeffN » Thu Dec 19, 2019 8:48 am

And keeps getting worse

Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity
December 19, 2019
N Engl J Med 2019; 381:2440-2450
DOI: 10.1056/NEJMsa1909301

https://www.nejm.org/doi/full/10.1056/N ... Zl3l9iB54s

BACKGROUND
Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity.

METHODS
We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup–specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993–1994 and 1999–2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes.

RESULTS
The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state.Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2).

CONCLUSIONS
Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.)

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Re: Optimum BMI?

Postby JeffN » Thu Dec 26, 2019 11:06 am

Mass Media Article

Key Point About Weight Loss and Breast Cancer Risk
For women 50 and over, losing weight is not enough
by Leah Lawrence, Contributing Writer, MedPage Today
December 17, 2019

https://www.medpagetoday.com/hematology ... ncer/83955

Women age 50 or older who were able to lose weight and keep it off over a 10-year period had a lower risk of breast cancer than women who maintained a stable weight, a new study showed. In fact, those women who were able to lose the greatest amount of weight were able to lower risk for breast cancer by as much as one-quarter, reported Lauren R. Teras, PhD, of the American Cancer Society in Atlanta, and colleagues.


Published Study

Sustained weight loss and risk of breast cancer in women ≥50 years: a pooled analysis of prospective data
JNCI: Journal of the National Cancer Institute, djz226, https://doi.org/10.1093/jnci/djz226
Published: 17 December 2019 Article history

Abstract

BACKGROUND
Excess body weight is an established cause of postmenopausal breast cancer, but it is unknown if weight loss reduces risk.

METHODS
Associations between weight change and risk of breast cancer were examined among women aged ≥50 years in the Pooling Project of Prospective Studies of Diet and Cancer. In 10 cohorts, weight assessed on three surveys was used to examine weight change patterns over approximately 10 years (Interval 1 median= 5.2 years; Interval 2 median = 4.0 years). Sustained weight loss was defined as ≥ 2kg lost in Interval 1 that was not regained in Interval 2. Among 180,885 women, 6,930 invasive breast cancers were identified during follow-up.

RESULTS
Compared with women with stable weight (± 2kg), women with sustained weight loss had a lower risk of breast cancer. This risk reduction was linear and specific to women not using postmenopausal hormones (>2-4.5kg lost: Hazard Ratio (HR)= 0.82, 95% confidence interval (CI): 0.70-0.96; >4.5-<9kg lost: HR = 0.75, 95% CI: 0.63-0.90; ≥9kg lost: HR = 0.68, 95% CI: 0.50-0.93). Women who lost ≥9kg and gained some (but not all) of it back were also at a lower risk of breast cancer. Other patterns of weight loss and gain over the two intervals had a similar risk of breast cancer to women with stable weight.

CONCLUSIONS
These results suggest that sustained weight loss, even modest amounts, is associated with lower breast cancer risk for women aged ≥50 years. Breast cancer prevention may be a strong weight loss motivator for the two-thirds of American women who are overweight or obese.
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Re: Optimum BMI?

Postby JeffN » Wed Mar 11, 2020 12:01 pm

The Real Biggest Losers - Documented Longterm Weight Loss Maintenance

Successful weight loss maintenance: A systematic review of weight control registries. Obesity Reviews. 2020;1–15. https:// doi.org/10.1111/obr.13003

https://onlinelibrary.wiley.com/doi/10.1111/obr.13003

Summary
Weight loss maintenance is a major challenge for obesity treatment. Weight control registries can be useful in identifying psychological and behavioural factors that could contribute to better long-term success. The objective of this study is to describe the existing weight control registries and their participants and identify correlates of weight loss maintenance. A comprehensive search of peer-reviewed articles publi- shed until November 2018 was conducted in PubMed, Web of Science, and Scopus. Studies that reported results from weight control registries were considered. Fifty- two articles, corresponding to five registries (the United States, Portugal, Germany, Finland, and Greece), were included. Registries differed in inclusion criteria and procedures. Of 51 identified weight loss and maintenance strategies, grouped in 14 domains of the Oxford Food and Activity Behaviors taxonomy, the following were the most frequently reported: having healthy foods available at home, regular breakfast intake, increasing vegetable consumption, decreasing sugary and fatty foods, limiting certain foods, and reducing fat in meals. Increased physical activity was the most consistent positive correlate of weight loss maintenance. To our knowledge, this is the first systematic review of information about successful weight loss maintenance obtained from weight control registries. Key common influential characteristics of success were identified, which can inform future prospective studies and weight management initiatives.
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Re: Optimum BMI?

Postby JeffN » Wed Mar 11, 2020 3:32 pm

From the text of the above study, separating the best and least effective strategies for both losing weight and for maintaining the weight loss.

For weight loss (WL)

The most frequently reported strategies (≥80%) for WL were classified in the following domains: planning content (having healthy foods available at home), dietary choices (regular breakfast intake and increasing vegetable consumption), energy compensation (engaging in physical activity/exercise), and regulation—restrictions (reducing the consumption of sugary and fatty foods, limiting intake of certain types of foods, and reducing fat in meals) domains. The least frequently reported strategies (≤20%) were in the following domains: support—professional (hypnosis, self-help/help from a weight control group, and help from a personal trainer or other professional), weight management aids (surgery, taking WL medication, using meal substitutes, and consuming WL supplements), information seeking (seeking WL information online), and regulation—restrictions (limiting intake to only one or two types of food and following a special or fad diet).

For Weight Loss Maintenance (WLM)

For WLM, the majority of participants (>80%) relied on regular breakfast intake, increasing the consumption of vegetables and fibre- rich foods (dietary choices domain); limiting intake of certain types of foods, reducing the consumption of fatty and sugary foods, and reducing fat in meals (regulation—restrictions domain); having healthy foods and few high-fat foods available at home (planning content domain); and having a regular meal frequency (regulation—rule setting domain). Less than 20% of participants reported taking WL medication, using meal substitutes, and consuming WL supplements (weight management aids domain); avoiding friends with excess weight and following a special or fad diet (regulation—restrictions domain); spending more time with normal-weight friends (regulation—rule setting domain); and having help from a weight control group (support— professional domain).
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Re: Optimum BMI?

Postby JeffN » Mon Apr 26, 2021 10:18 am

Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK
BMC Public Health volume 21, Article number: 576(2021)

https://bmcpublichealth.biomedcentral.c ... 21-10606-1

Background
Although obesity is a well-recognised risk factor for cardiovascular disease (CVD), the impact of long-term body mass index (BMI) changes in overweight or obese adults, on the risk of heart failure, CVD and mortality has not been quantified.

Methods
This population-based cohort study used routine UK primary care electronic health data linked to secondary care and death-registry records. We identified adults who were overweight or obese, free from CVD and who had repeated BMI measures. Using group-based trajectory modelling, we examined the BMI trajectories of these individuals and then determined incidence rates of CVD, heart failure and mortality associated with the different trajectories. Cox-proportional hazards regression determined hazards ratios for incident outcomes.

Results
264,230 individuals (mean age 49.5 years (SD 12.7) and mean BMI 33.8 kg/m2 (SD 6.1)) were followed-up for a median duration of 10.9 years. Four BMI trajectories were identified, corresponding at baseline, with World Health Organisation BMI classifications for overweight, class-1, class-2 and class-3 obesity respectively. In all four groups, there was a small, stable upwards trajectory in BMI (mean BMI increase of 1.06 kg/m2 (± 3.8 )). Compared with overweight individuals, class-3 obese individuals had hazards ratios (HR) of 3.26 (95% CI 2.98–3.57) for heart failure, HR of 2.72 (2.58–2.87) for all-cause mortality and HR of 3.31 (2.84–3.86) for CVD-related mortality, after adjusting for baseline demographic and cardiovascular risk factors.

Conclusion
The majority of adults who are overweight or obese retain their degree of overweight or obesity over the long term. Individuals with stable severe obesity experience the worst heart failure, CVD and mortality outcomes. These findings highlight the high cardiovascular toll exacted by continuing failure to tackle obesity.
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